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Self perceived health in Ukraine: results of a cross sectional survey

Self perceived health in Ukraine: results of a cross sectional survey. Dr Anna Gilmore EUROPEAN CENTRE ON HEALTH OF SOCIETIES IN TRANSITION London School of Hygiene and Tropical Medicine. UKRAINE. Life expectancy at birth. Evidence from Russia. Shows:

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Self perceived health in Ukraine: results of a cross sectional survey

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  1. Self perceived health in Ukraine:results of a cross sectional survey Dr Anna Gilmore EUROPEAN CENTRE ON HEALTH OF SOCIETIES IN TRANSITION London School of Hygiene and Tropical Medicine

  2. UKRAINE

  3. Life expectancy at birth Source: WHO HFA database

  4. Evidence from Russia • Shows: • Fall in LE accounted for by increase in cardiovascular and external causes of death • young and middle aged males in lower educational groups • regions undergoing the most rapid economic change • Has led experts to suggest that 3 main factors underpin the fall: • Material factors (impoverishment) • Psychosocial factors (instability, stress of change) • Lifestyle factors (alcohol)

  5. We therefore used a cross sectional survey to examine: 1. Distribution of health in Ukraine 2. Determinants of health in Ukraine • Impact of s/e and p/s factors on health • Relative importance of these factors 3. Could control explain socioeconomic or psychosocial differences in health? 4 Did social networks buffer the impact of these stressors on health?

  6. Survey methodology • Cross sectional survey of self perceived health • Feb-March 2000 • Nationally representative sample of adults18+ • Multi-stage random sampling technique with the no. of interviews within each area allocated according to population size. • Trained interviewers • Quality control: In 10% a supervisor present • 1590 interviews completed: Response rate 72%

  7. What is self perceived health? • Respondents rate their own health on a 5-point scale • Shown to be a valid and reliable measure of overall health • Predictive of mortality and later disability

  8. Results: 1. Distribution of self perceived health, sexes combined

  9. 2. Determinants of health: binary logistic regression Variables: • Demographic: • age, sex, urban/rural, education, nationality, language • Socioeconomic: • Income, material situation, employment • Psychosocial: • social position, change in social position, control, • social networks: ability to borrow money from family or friends, family relations, marital status, Communist Party membership, membership of a religion • Lifestyle: smoking Analysis: • Age, sex adjusted • Age, sex, education, urban/rural • Multivariable analysis (10 variables)

  10. OR for average or worse health: sociodemographic factors

  11. OR for average or worse healthsociodemographic factors cont’d

  12. OR for average or worse health: socio-economic factors

  13. OR for average or worse health: psychosocial factors

  14. OR for average or worse health: Psychosocial factors cont’d

  15. 3. Does control mediate the effect of material and social position on health?

  16. 4. Do social networks buffer impact of s/e and p/s stressors on health? OR for less than good self-perceived health Controlling for: unemployed Deterioration in social pos’n

  17. Issues/limitations of this study • Power to detect significant differences, particularly in sub-group analyses was limited by sample size. • No data on alcohol consumption which is an important health determinant in the former Soviet Union. • A cross-sectional survey and hence the time sequence and causality of events is difficult to establish.

  18. Conclusions • Low levels of self rated health in Ukraine • Marked gender and geographic inequalities • Socio-economic factors (material situation) and psychosocial factors (control, deterioration in social position) are independent health determinants • Control over life accounts for the negative impact of low social position on health • Good family relations appear to protect against poor health but unclear how this works

  19. Suggest that reduction in material wealth, loss of control and ‘change’ may all have contributed to decline in life expectancy seen with transition.

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